| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MELISSA WIDUCKI3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $8K | $624 | $9K | 12.13% |
| BEJAMIN BAKER3 | 5351 BROADWAY ST NEWALD, WI 54511 | AFLAC | $3K | — | $3K | 4.20% |
| RICKY E ROBINSON3 Filed as: RICKY ROBINSON | 934 SWEENEY DR STE ONE HAGERSTOWN, MD 21740 | AFLAC | $864 | $71 | $935 | 1.29% |
| BRIAN S LOWE3 | 920 SARDIS DR BOAZ, AL 35956 | AFLAC | $874 | — | $874 | 1.21% |
| LISA M LOUDIN3 Filed as: LISA LOUDIN | 2129 GUILFORD RD ROCKFORD, IL 61107 | AFLAC | $713 | $43 | $756 | 1.04% |
| ALICE MAGUIRE3 | 4512 TWIN PINES LN WESTON, WI 54476 | AFLAC | $732 | — | $732 | 1.01% |
| JOHN BROOKS3 | 4031 LEETH GAP RD BOAZ, AL 35956 | AFLAC | $706 | — | $706 | 0.97% |
| ALISON M MORROW3 Filed as: ALISON MORROW | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $584 | $95 | $679 | 0.94% |
| LYNN KARL3 | W10030 PARKSIDE LN ANTIGO, WI 54409 | AFLAC | $500 | $71 | $571 | 0.79% |
| DAVID R PONTA3 Filed as: DAVID PONTA | 145 S DUKE ST STE B YORK, PA 17401 | AFLAC | $299 | — | $299 | 0.41% |
| DEWAYNE D RAY3 | PO BOX 41 GUNTERSVILLE, AL 35976 | AFLAC | $260 | — | $260 | 0.36% |
| PETER J TEKAMPE3 | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $180 | $9 | $189 | 0.26% |
| DAVID W BRANDT3 Filed as: DAVID BRANDT | 46 WINDSOR WAY RED LION, PA 17356 | AFLAC | $174 | — | $174 | 0.24% |
| MICHAEL J SKOFF3 Filed as: MICHAEL SKOFF | 815 N CHURCH ST ROCKFORD, IL 61103 | AFLAC | $137 | $9 | $146 | 0.20% |
| BARBARA ANN MCNAUGHTON3 | 4910 CORPORATE DR NW STE G HUNTSVILLE, AL 35805 | AFLAC | $144 | — | $144 | 0.20% |
| DANIEL L OJA3 | 6015 OAKES AVE SUPERIOR, WI 54880 | AFLAC | $133 | — | $133 | 0.18% |
| BETH LUANNE KIMBROUGH3 Filed as: BETH KIMBROUGH | 6750 N ANDREWS AVE STE 200 FT LAUDERDALE, FL 33309 | AFLAC | $128 | — | $128 | 0.18% |
| BRYAN FISH3 | 4050 CANDLE LIGHT DR DAYTON, MD 21036 | AFLAC | $61 | $12 | $73 | 0.10% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $73 | — | $73 | 0.10% |
| TRICIA BLAIR3 | 311 FINANCIAL WAY STE 220 WAUSAU, WI 54401 | AFLAC | $72 | — | $72 | 0.10% |
| ROBERT J DONOHUE3 Filed as: ROBERT DONOHUE | 808 FAIRWAY DRIVE MOSINEE, WI 54455 | AFLAC | $66 | — | $66 | 0.09% |
| MARK JOHNSTON3 | 124 UNDERKE TER HEDGESVILLE, WV 25427 | AFLAC | $58 | — | $58 | 0.08% |
| RAMON PURVIS3 | 380 VALLEY DR FAYETTEVILLE, PA 17222 | AFLAC | $43 | — | $43 | 0.06% |
| KELVIN MICHAEL RICE3 | 106 HULSEY LN TONEY, AL 35773 | AFLAC | $43 | — | $43 | 0.06% |
| GLEN T SCHWEIKERT3 Filed as: GLEN SCHWEIKERT | 2211 HIGHLAND SPRINGS PL LOUISVILLE, KY 40245 | AFLAC | $33 | — | $33 | 0.05% |
| GLEN T SCHWEIKERT3 | 2211 HIGHLAND SPRINGS PL LOUSVILLE, KY 40245 | AFLAC | $33 | — | $33 | 0.05% |
| TRICIA SCHOENECK3 | 3462 COLUMBUS LAKE RD EAGLE RIVER, WI 54521 | AFLAC | $32 | — | $32 | 0.04% |
| JASON SCZEPANIAK3 | 1161 HERITAGE CT SUN PRAIRIE, WI 53590 | AFLAC | $29 | — | $29 | 0.04% |
| PATRICK KREFT3 | 107 EDDY RD EDGAR, WI 54426 | AFLAC | $29 | — | $29 | 0.04% |
| KIMBERLY L LUSHBAUGH3 Filed as: KIMBERLY LUSHBAUGH | 14 CATAWBA CIRCLE HAGERSTOWN, MD 21742 | AFLAC | $28 | — | $28 | 0.04% |
| JAMEY MILLER INC3 | 10375 CENTURION PRKWY N STE 100 JACKSONVILLE, FL 32256 | AFLAC | $25 | — | $25 | 0.03% |
| MICHAEL C WALKER3 Filed as: MICHAEL WALKER | 203 MARKET ST STE 201 HARVRE DE GRACE, MD 21078 | AFLAC | $18 | — | $18 | 0.02% |
| JAMEY MILLER INC3 | 2202 57TH ST SE AUBURN, WA 98092 | AFLAC | $18 | — | $18 | 0.02% |
| SAMANTHA J BREUER3 | E4355 PINEWOOD CIR ELEVA, WI 54738 | AFLAC | $18 | — | $18 | 0.02% |
| STEVEN T SPEICHINGER3 Filed as: STEVEN SPEICHINGER | 3008 CHRISTIAN AVE WAUSAU, WI 54401 | AFLAC | $17 | — | $17 | 0.02% |
| SAMANTHA J LEITERITZ3 | 1137 RALEIGH ST GREEN BAY, WI 54304 | AFLAC | $6 | $10 | $16 | 0.02% |
| BRANDT INC3 | 3111 EXPRESSO WAY YORK, PA 17406 | AFLAC | $15 | — | $15 | 0.02% |
| MARK D BARBIER3 Filed as: MARK BARBIER | 23 CROYDON LN OAK BROOK, IL 60523 | AFLAC | $15 | — | $15 | 0.02% |
| ARON D TERAN3 Filed as: ARON TERAN | 3812 CARRIAGE HILL DR FREDERICK, MD 21704 | AFLAC | $13 | — | $13 | 0.02% |
| DENNIS J CASSENS3 Filed as: DENNIS CASSENS | 4646 E MARRILL RD STE 1 BYRON, IL 61010 | AFLAC | $12 | — | $12 | 0.02% |
| JEREMY KOOI3 | 270 SHAKERAGE ST MINERAL POINT, WI 53565 | AFLAC | $11 | — | $11 | 0.02% |
| IRENE E BROOKS3 Filed as: IRENE BROOKS | 101 COPPER BEECH LN WOMELSDORF, PA 19567 | AFLAC | $10 | — | $10 | 0.01% |
| MICHAEL C WALKER3 Filed as: MICHAEL RISKA | 203 MARKET ST STE 201 HARVE DE GRACE, MD 21078 | AFLAC | $9 | — | $9 | 0.01% |
| KHRYSTEN KAYE GOSS3 | 2550 OLD ALEX CT OSHKOSH, WA 54904 | AFLAC | $2 | $7 | $9 | 0.01% |
| WILLIAM F MURRAY III3 Filed as: WILLIAM MURRAY III | 1298 SAINT PATRICK WAY SUN PRAIRIE, WI 53590 | AFLAC | $7 | — | $7 | 0.01% |
| SAMANTHA MICHAELSON3 Filed as: SAMANTHA BREUER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $7 | — | $7 | 0.01% |
| JASON D ELLIS3 Filed as: JASON ELLIS | 203 MARKET STREET STE 210 HAVRE DE GRACE, MD 21078 | AFLAC | $6 | — | $6 | 0.01% |
| JEFFREY A. MUSSOLINO3 Filed as: JEFFREY A MUSSOLINO | 805 HAMILTON BLVD HAGERSTOWN, MD 21742 | AFLAC | $6 | — | $6 | 0.01% |
| CHRISTOPHER J ZELLNER3 Filed as: CHRISTOPHER ZELLNER | 918 ALDORA LN WAUNAKEE, WI 53597 | AFLAC | $5 | — | $5 | 0.01% |
| ROSS C NELSON3 Filed as: ROSS NELSON | 440 REGENCY PARKWAY DR STE 234 OMAHA, NE 68114 | AFLAC | $5 | — | $5 | 0.01% |
| PAUL W DESPIRITO3 | 3051 PROGESS WAY STE 204 KAUKAUNA, WI 54130 | AFLAC | $2 | $3 | $5 | 0.01% |
| MARSH & MCLENNAN AGENCY LLC3 | PO BOX 510925 NEW BERLIN, WI 53151 | AFLAC | $3 | — | $3 | 0.00% |
| RYAN R KRUEGER3 Filed as: RYAN KRUEGER | 6234 TRANQUIL RIVER LN WAUSAU, WI 54401 | AFLAC | $3 | — | $3 | 0.00% |
| ADAM THOMAS GARDNER3 Filed as: ADAM GARDNER | 101 N FARWELL ST STE 203 EAU CLAIRE, WI 54703 | AFLAC | $2 | — | $2 | 0.00% |
| TIMOTHY ASBY3 | 11500 GOLDEN WILLOW CT ZIONSVILLE, IN 46077 | AFLAC | $2 | — | $2 | 0.00% |
| FRANCES SHAFFER3 | 14025 TOWER RD SMITHSBURG, MD 21783 | AFLAC | $2 | — | $2 | 0.00% |
| NATHAN BRONSON3 | W217 N5386 TAYLORS WOODS DR MENOMONEE FALLS, WI 53051 | AFLAC | $1 | — | $1 | 0.00% |
| JEREMY A FELDMAN3 Filed as: JEREMY FELDMAN | 15324 SWEETBAY ST WOODBINE, MD 21797 | AFLAC | $1 | — | $1 | 0.00% |
| ELIZABETH A LENZO3 | 701 ALBEROSKY WAY BATAVIA, IL 60510 | AFLAC | $1 | — | $1 | 0.00% |
| CHRISTINE LOGSLETT3 | 300 N CORPORATE DR STE 300 BROOKFIELD, WI 53045 | AFLAC | $1 | — | $1 | 0.00% |
| SHADEL & ASSOCIATES LLC3 Filed as: SHADEL & ASSOCIATES INC | 4811 BEACH BLVD NEPTUNE BEACH, FL 32266 | AFLAC | $1 | — | $1 | 0.00% |
| CHRISTINE LOGSLETT3 | 8318 ANNA AVE WIND LAKE, WA 53185 | AFLAC | $1 | — | $1 | 0.00% |
| JOHNSON INSURANCE SERVICES LLC3 Filed as: JOHNSON INSURANCE SERVICES | 555 MAIN ST. STE 291 RACINE, WI 534031000 | SUPERIOR VISION INSURANCE PLAN OF WISCONSIN, INC. | $2K | — | $2K | 10.00% |
| JOHNSON INSURANCE SERVICES LLC3 | 555 MAIN ST STE 291 RACINE, WI 53403 | PRINCIPAL LIFE INSURANCE COMPANY | $663 | $74 | $737 | 10.47% |
| ROGERS BENEFIT GROUP INC3 | 5110 N 40TH ST STE 234 PHOENIX, AZ 85018 | PRINCIPAL LIFE INSURANCE COMPANY | $271 | — | $271 | 3.85% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| PRAIRIE STATES CLAIMS PROCESSING | Claims processing Service code 12 | 401 NORTH MICHIGAN AVE STE 2902 CHICAGO, ID 60611 | $37K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $6K |
| JOHNSON INSURANCE SERVICES LLC INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | 555 MAIN ST. STE 291 RACINE, WI 53403 | $2K |
| COFINITY EIN 20-1274723 CLAIMS PROCESSING | Other insurance fees and expenses; Claims processing Service code 12 | — | $0 |
| FH GROUP CORP EIN 20-1736437 CLAIMS PROCESSING | Other insurance fees and expenses; Claims processing Service code 12 | — | $0 |
| GLOBALCARE EIN 31-1407689 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $0 |
| PHCS/MULTIPLAN EIN 39-1634080 CLAIMS PROCESSING | Claims processing; Other insurance fees and expenses Service code 12 | — | $0 |
| PREFERREDONE EIN 41-1846481 OTHER INS FEES | Other insurance fees and expenses Service code 73 | — | $0 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 158 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 160 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | AFLAC | 130 | $72K |
| Vision(2 contracts, 2 carriers) | AFLAC | 130 | $90K |
| Life insurance | PRINCIPAL LIFE INSURANCE COMPANY | 174 | $7K |
| Stop-loss / reinsurancereinsurance | WESTPORT INSURANCE CORP | 116 | $332K |
| Other(2 contracts, 2 carriers) | WESTPORT INSURANCE CORP | 130 | $404K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 174 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.